Jul 16th 2015

On the Importance of Dignitas International

On the Importance of Dignitas International

I am hosting an event at my house Thursday to shine a light on Dignitas International.  I joined the board of this organization about a year ago.   At first glance you might wonder why a urologist without any expertise in infectious disease or HIV would want to join such an organization. I know about men’s health and kidney stones; prostate cancer and urinary tract infections. As I reflect on my near 20 year career however, it seems like a natural evolution.


Like most specialists as I finished my training I embarked upon my practice with great confidence in my skills and some trepidation.  Although lacking for experience, I felt I could look after many complex problems.    I have cared for many patients over the years. This includes all elements of general urology as well as complex stone cases from across Ontario and urological malignancies.  It is a technologically demanding specialty that relies very much on adequate funding and resources.   Over time I have started to realize that despite the constraints of our healthcare system (and my complaints about it) I still am able to draw on resources needed to deliver the best in modern urological care to my patients. Giving advice based upon the best evidence available from around the world is assumed.  In many respects as I reflect on this as a surgeon living in Canada there is an element of good fortune that comes with it.


As time goes on however I am also struck by the notion that while surgical outcomes in large measure depend upon appropriate decision-making and completing a task efficiently there are many factors upon which I have less control. Outcomes can vary widely depending on a patient's access to social support and community. Lack of computer literacy, particularly among the elderly is still an impediment to healthcare.  Others can’t afford the cost of drugs they are prescribed. Still others may skip an appointment if it means an expensive cab ride or jeopardizing their position at work. Social economic determinants of disease really do matter.  Here. Today. In Canada.


Imagine then if we look at this inequity and lack of access on a more global scale.


The HIV pandemic has been well documented and has been a catastrophe particularly in the developing world. In 2003 Malawi was no exception.   In the west, access to modern drug therapy has effectively made HIV a chronic disease.   In Sub-Saharan Africa it resembles a clinical course I remember from medical school in the 1980s.  Even the natural history of prostate cancer, often a slow-moving disease for many here, is fundamentally different due to a big gap in basic primary care.  


In 2004 James Orbinksi co-founded Dignitas International. In those 10 years a remarkable transformation has occurred.  To date over 200,000 people have been placed on antiretroviral care.   Clinics designed to educate people, reduce maternal to child transmission and break down stigma continue to inspire.  The integrated HIV-TB clinic is a model for others.   Hundreds of healthcare workers have been trained to provide support at nearly 200 facilities.  Thursday's keynote speaker, Gabriel Mateyu, has been instrumental in the drive to decentralize HIV care in Malawi.   Reading through DI's 2014 annual report highlights its many achievements


Essentially what this all speaks to is bringing access to fair and reasonable health care to every human being and addressing some of those gaps in care.    While not immediately apparent, the health of the developed world will be increasingly tied to what happens around the globe.   The recent Ebola outbreak highlights that.  As this very important organization looks ahead it is hoping to build on its experience and scale what is has learned in HIV care and potentially other important diseases in Malawi to elsewhere in the developing world. Learning from our experience abroad can also lead to a better understanding in trying to bridge gaps in healthcare back home.   DI’s vision to address this domestically with our aboriginal population is one such example.


The future is bright but much work remains. Healthcare workers in every capacity around the world must be willing to understand care outside of local sensibilities.     The movements of Dignitas will be worth following.

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